Decreased expression of MLH1, MSH2, PMS1 and PMS2 in pigmented lesions indicates accumulation of failed DNA repair along with malignant transformation and tumour progression

The tumorigenesis of human nonpolyposis colorectal cancer was reported to be connected with the mutations in DNA mismatch repair genes. The main aim of this study was to check the epression of 4 proteins MLH1, MSH2, PMS1 and PMS2 responsible for mismatch DNA repair in naevi and melanomas. Fifty-one naevi, 78 primary melanomas, 30 lymphatic and 7 organ melanoma metastases were stained for the presence of MLH1, MSH2, PMS1 and PMS2. All proteins were preserved in 88% of naevi and only in 37% of primary melanomas, 17% of lymphatic metastases and in none of the distant metastases. The difference of expression of all 4 proteins between naevi and melanomas was highly significant (p<0.01). MLH1 and MSH2 correlated significantly with each other as well with the follow-up of patients. On the basis of our results one can conclude that the defect of mismatch DNA repair plays an important role in both tumorigenesis of melanoma and metastatic spread of tumour.

Effect of curcumin on atherosclerosis in apoE/LDLR-double knockout mice

It is widely appreciated that inflammation and oxidant stress contribute to atherogenesis. Curcumin, a polyphenolic natural compound has been reported to possess anti-inflammatory and anti-oxidant actions. We hypothesized that curcumin could inhibit the development of atherosclerosis in the apoE/LDLR-double knockout mice fed with Western diet (21% fat, 0.15% cholesterol w/w, without cholic acid). Curcumin (purity>or=98%), premixed with diet, was given for 4 months at a dose of 0.3 mg/ per day/ per mouse. In this model curcumin inhibited atherogenesis, measured both by "en face" method (25,15+/-2,9% vs. 19,2+/-0,6%, p<0,05) and "cross-section" method (565867+/-39764 microm2 vs. 299201+/-20373 microm2, p<0,05). Importantly, curcumin influenced neither the concentrations of cholesterol and triglycerides in blood nor animal body weight. To our knowledge, this is the first report that shows the anti-atherogenic effect of low dose of curcumin in fine model of atherosclerosis: gene-targeted apoE/LDLR-double knockout mice.

Inhibition of nuclear factor-kappaB attenuates artherosclerosis in apoE/LDLR - double knockout mice

Nuclear factor - kappaB (NF-kappaB) is a good therapeutic target for cardiovascular disease and numerous efforts are being made to develop safe NF-kappaB inhibitors. Nowadays many authors address NF-kappaB as a major therapeutic target in atherosclerosis, especially for preventive measures, in the light of two main hypothesis of atherosclerosis: oxidation and inflammation. We hypothesized that ammonium pyrrolidinedithioocarbamate (PDTC) - a well-known inhibitor of NF-kappaB could inhibit the development of atherosclerosis in this experimental model. We used apoE/LDLR - DKO mouse model, which is considered as a one of the best models to study the anti-atherosclerotic effect of drugs. In this model PDTC inhibited atherogenesis, measured both by "en face" method (25,15+/-2,9% vs. 15,63+/-0,6%) and "cross-section" method (565867+/-39764 microm2 vs. 291695+/-30384 microm2). Moreover, PDTC did not change the profile of cholesterol and triglycerides in blood. To our knowledge, this is the first report that shows the effect of PDTC on atherogenesis in gene-targeted apoE/LDLR - double knockout mice.

Downregulation of the retinoblastoma gene expression in the progression of malignant melanoma

The retinoblastoma gene is a cell cycle regulator preventing cells from entering into S-phase. An altered expression of the retinoblastoma gene has been reported in the majority of human malignancies. The main aim of this study was to investigate retinoblastoma gene expression in the full spectrum of melanoma progression from naevus to melanoma metastases by applying immunohistochemistry and RT-PCR. All naevi with and without dysplasia showed high expression of the retinoblastoma gene. In primary melanomas, Rb-positive cells were found in 82 out of 106. Loss of expression correlated with an increase in Clark level and shorter survival rates. An independent prognostic role of the retinoblastoma gene was confirmed by Cox multivariate analyses (p < 0.01). In melanoma metastases, retinoblastoma gene expression (at the RNA level) was found in 18 out of 26 melanoma lymphatic metastases, and in 2 out of 5 liver metastases. Our results indicate a downregulation of the retinoblastoma gene in the progression of melanocytic tumours.

GADD153 is an independent prognostic factor in melanoma: immunohistochemical and molecular genetic analysis

The main role of growth arrest and DNA damage-inducible (GADD) genes is to block proliferation at G1 and G2 checkpoints in response to DNA damage. The goal of this study was to examine the expression of GADD genes in primary melanomas with respect to prognosis. GADD34 was found in 73% of the primary melanomas investigated. GADD45 and GADD153 were positive in 60% and 80% of primary melanomas, respectively. Cox regression demonstrated that only GADD153 had any independent prognostic impact. We therefore decided to establish a PCR assay for detection of GADD153 in paraffin-embedded tissue. GADD153 deletion was found in 3/26 melanomas. None of the 3 cases with GADD153 deletion showed any expression of GADD153. Sequencing analysis detected polymorphism T-C at amino acid position 10 in 6/23 melanomas. In 6 cases with GADD153 polymorphism, GADD153 expression was found in 2 melanomas with a maximum GADD153 index of 10%. We postulate that the GADD gene family plays an important role in melanoma progression.

Interleukin 16 expression and phenotype of interleukin 16 producing cells in Crohn's disease

BACKGROUND

The mechanisms involved in the initiation and maintenance of Crohn's disease are poorly understood. Previous studies have demonstrated an increased number of infiltrating CD4+ T cells within the inflammatory affected bowel wall in Crohn's disease. Novel therapy approaches using anti-CD4 antibodies are thought to be effective in Crohn's disease.

AIMS

Interleukin 16 (IL-16) has been characterised as a chemokine with selective chemoattraction for CD4+ inflammatory T cells. In this study, cellular expression of IL-16 in Crohn's disease and ulcerative colitis was investigated.

METHODS

Expression of IL-16 was analysed in tissue samples of Crohn's disease, ulcerative colitis, and normal controls by applying reverse transcription-polymerase chain reaction, non-radioactive in situ hybridisation, and immunohistochemistry. Double staining methods were used to characterise cells expressing IL-16. The amount of infiltrating CD4+ cells was determined by immunohistochemistry and correlated with the corresponding IL-16+ cell number by step sections.

RESULTS

An increased number of IL-16+ cells in Crohn's disease in comparison with ulcerative colitis and control probes was demonstrated. IL-16 was expressed by CD4 and CD8 positive T cells. In addition, in active Crohn's disease there was a substantial number of IL-16 positive mast cells. The increased number of CD4+ lymphocytes correlated positively with the increased number of IL-16 positive cells in Crohn's disease.

CONCLUSION

Our results demonstrate that increased expression of IL-16 in T cells and mast cells in active Crohn's disease is associated with increased numbers of CD4+ lymphocytes. Local expression of IL-16 seems to play a significant role in the initiation and persistence of the inflammatory process in Crohn's disease, presumably by IL-16 mediated recruitment of CD4+ cells, mostly lymphocytes, into the bowel wall.

Relationship between DNA ploidy-related parameters and the deletions in mismatch repair genes MLH1 and MSH2 in lentigo maligna and malignant melanomas

Defects in DNA mismatch repair genes MLH1 and MSH2, first described in hereditary nonpolyposis colon cancer (HNPCC), have been postulated to be responsible for malignant transformation in several tumours. To date there are no data on cutaneous tumours. Using a PCR assay it was possible to identify deletions in MSH2 (exonic regions 12 and 13) in 16 of 47 lentigos maligna and in 10 of 36 malignant melanomas. Deletions in MLH1 (exonic regions 15 and 16) were found in 11 of 47 lentigos and in 15 of 36 melanomas. Comparison of DNA ploidy-related parameters between lentigos with and without exonic deletions in MSH2 and MLH1 did not show any significant differences. In contrast, melanomas positive and negative for exons 12 and 13 (MSH2) (26/36 and 10/36, respectively) differed significantly with respect to the percentages of diploid cells (P = 0.0179) and tetraploid cells (P = 0.0042). Comparison of melanomas positive and negative for exons 15 and 16 (MLH1) (21/36 and 15/36, respectively) showed significant differences in the percentage of aneuploid cells between 2c and 4c (P = 0.0141) and tetraploid cells (P = 0.0404). In summary, deletions in DNA mismatch repair proteins MSH2 and MLH1 were present both in lentigo maligna and in melanomas and correlated with DNA ploidy-related parameters in malignant melanomas.

Relation between DNA ploidy status and the expression of the DNA-mismatch repair genes MLH1 and MSH2 in cytological specimens of melanoma lymph node and liver metastases

DNA-mismatch repair is essential for preventing genetic instability, and its important protective role has been demonstrated in several tumors. The main aim of this study was to investigate the expression of MLH1 and MSH2 (on the RNA level) in melanoma liver and lymph node metastases, and to define the relation between DNA ploidy status and mismatch repair gene expression. MLH1 was found in 29/33 melanoma lymph node and in 5/17 melanoma liver metastases. MSH2 was present in 26/33 lymph node and 5/17 liver metastases. A comparison of MLH1 and MSH2 positive and negative melanoma metastases showed that there were highly significant differences in the percentages of diploid cells, aneuploid cells between 4c and 8c, octaploid cells, and 5c exceeding rate. This fact confirms the strong relation between the loss of DNA-mismatch repair gene expression and advanced DNA aneuploidy status in melanoma metastases.

Comparative study of the expression of DNA mismatch repair genes, the adenomatous polyposis coli gene and growth arrest DNA damage genes in melanoma recurrences and metastases

The main goal of this study was to examine the expression of DNA mismatch repair genes (MLH1, MSH2, PMS1 and PMS2), the adenomatous polyposis coli (APC) gene and growth arrest DNA damage inducible (GADD) genes (GADD34, GADD45 and GADD153) in the different stages of melanoma recurrences and metastases, and to identify any mutual consistencies in their expression pattern. All the cases of primary melanoma examined showed a reduced expression of DNA repair genes. These results demonstrate that disturbances of DNA repair begin in the early stages of melanoma. No significant differences were found in the expression of these markers between cutaneous melanomas and their recurrences and metastases (P> 0.05). Eighteen significant correlations between markers were found in the primary melanomas, and 10 significant correlations were observed in the first recurrences of melanoma. In contrast, 27 statistically significant relationships were demonstrated in metastatic lymph nodes. The different correlations found in primary and metastatic tumours confirmed the hypothetical difference in marker interaction in the diagnostic groups investigated. Our results suggest that DNA repair genes may play an important role in the recurrence and metastasis of melanomas.

Analysis of the DNA mismatch repair proteins expression in malignant melanomas

The importance of properly functioning DNA mismatch repair has been shown in several tumour types both hereditary and sporadic, but not yet in malignant melanomas. The aim of this study was to examine the expression of DNA mismatch repair genes (MLH1, MSH2, PMS1 and PMS2) in primary melanomas and to define their possible prognostic impact in 106 primary melanomas. MLH1 was found in 64 and MSH2 in 61 out of 106 melanomas. PMS1 and PMS2 proteins were present in 69 and 67 tumours, respectively. Loss of the expression of DNA mismatch repair proteins correlated with the increase of Clark levels. Cox regression analysis demonstrated some prognostic significance for PMS1 (forward p = 0.0018 and backward selections p = 0.0277), MLH1 (only forward selection p = 0.0081) and MSH2 (only backward selection p = 0.0115).

Detection of inflammation- and neoplasia-associated alterations in human large intestine using plant/invertebrate lectins, galectin-1 and neoglycoproteins

Commonly, plant and invertebrate lectins are accepted glycohistochemical tools for the analysis of normal and altered structures of glycans in histology and pathology. Mammalian lectins and neoglycoproteins are recent additions to this panel for the detection of lectin-reactive carbohydrate epitopes and glycoligand-binding sites. The binding profiles of these three types of probes were comparatively analyzed in normal, inflamed and neoplastic large intestine. In normal colonic mucosa the intracellular distribution of glycoconjugates and carbohydrate ligand-binding sites in enterocytes reveals a differential binding of lectins with different specificity and of neoglycoproteins to the Golgi apparatus, the rough and smooth endoplasmic reticulum and the apical cell surface. The accessible glycoligand-binding sites and the lectin-reactive carbohydrate epitopes detected by galectin-1 show the same pattern of intracellular location excluding the apical cell surface. Lectin-reactive carbohydrate epitopes detected by plant lectins of identical monosaccharide specificity as the endogenous lectin [Ricinus communis agglutinin-I (RCA-I), Viscum album agglutinin (VAA)], however, clearly differ with respect to their intracellular distribution. Maturation-associated differences and heterogeneity in glycohistochemical properties of epithelial cells and non-epithelial cells (macrophages, dendritic cells, lymphocytes) are found. Dissimilarities in the fine structural ligand recognition of lectins with nominal specificity to the same monosaccharide have been demonstrated for the galactoside-specific lectins RCA-I, VAA and galectin-1 as well as the N-acetylgalactosamine (GalNAc)-specific lectins Dolichos biflorus agglutinin (DBA), soybean agglutinin (SBA) and Helix pomatia agglutinin in normal mucosa and in acute appendicitis. Acute inflammation of the intestinal mucosa found in acute phlegmonous appendicitis is associated with selective changes of glycosylation of mucin in goblet cells mainly of lower and middle crypt segments resulting in an increase of DBA- and SBA-binding sites in the goblet cell population. Appendicitis causes no detectable alteration of neoglycoprotein binding. In contrast, tumorigenesis of colonic adenoma is characterized by increases in lectin-reactive galactose (Gal; Gal-beta1, 3-GalNAc), fucose and N-acetylglucosamine moieties and by enhanced presentation of respective carbohydrate ligand-binding capacity. This work reveals that endogenous lectins and neoglycoproteins are valuable glycohistochemical tools supplementing the well-known analytic capacities of plant lectins in the fields of gastrointestinal anatomy and gastroenteropathology.

Analysis of the DNA content in the progression of recurrent and metastatic melanomas

Ploidy status and ploidy related parameters of 18 primary melanomas, 32 recurrences and 18 lymphatic metastases were investigated applying CAS200 image analyzer. All the tumours investigated were either suspicious for aneuploidy (Auer III) or clearly aneuploid (Auer IV). Primary melanomas differed from recurrent tumours concerning the percentage of aneuploid cells between 4c and 8c and 5c ER. Comparison of cutaneous tumours with lymphatic metastases showed a significant difference concerning the percentage of aneuploid cells between 2c and 4c. An already high aneuploidy rate in primary tumours suggests that recurrent and metastatic clones of cells are present in early stages and that aneuploidy status in primary melanomas could be regarded as one of the risk factors of recurrences and metastases.

Prognostic significance of newly defined ploidy related parameters in melanoma

5c exceeding rate is the parameter, most frequently showing prognostic impact. The CAS200 image analyzer makes possible the measurement of additional parameters defining single subfractions of cells, as for example the ratios of diploid, aneuploid, tetraploid, octaploid and 16-ploid cells. The main objective of this study was to define the prognostic significance of these new parameters in 106 primary melanomas with known survival time. 29 out of 106 melanomas were euploid. 77 out of 106 showed an aneuploid histogram. Multivariate analysis with Cox regression demonstrated that the percentage of aneuploid cells between 2c and 4c and the percentage of aneuploid cells between 4c and 8c, but not 5c exceeding rate, were able to influence survival time.

Proliferative activity in the progression of pigmented skin lesions, diagnostic and prognostic significance

Proliferative compartments of a tumour can be determined cytophotometrically, by in situ hybridisation or by immunohistochemical detection of Ki67 antigen. The main objective of this study was to analyse the proliferative activity during the progression of pigmented skin lesions with respect to differential diagnostic and prognostic applications. The material investigated consisted of 209 pigmented skin lesions (31 naevi, 30 dysplastic naevi, 106 primary melanomas, 20 lymphatic and 22 organ melanoma metastases). Comparison of the ratios of cells in the S-phase gained by two different methods (cytometry, in situ hybridisation) did not show any significant differences. The correlations between Ki67 and S-phase indices in every diagnostic group were highly significant. The results of forward and backward Cox regression were identical and only Ki67 showed an independent prognostic influence (p < 0.001, coefficient in regression 0.02) with change in risk 2% and confidence limit ranging between 1.1% and 2.9%.

Myoepithelial sialadenitis versus low-grade non-Hodgkin's lymphoma of the salivary gland in FNAB: is discrimination by means of an image processing system possible?

The diagnosis of myoepithelial sialadenitis (MESA) in fine needle aspiration biopsy may be difficult. There is a dense lymphocytic infiltration in the gland and discrimination between a hyperimmune reaction and a low grade non-Hodgkin's lymphoma (NHL) of B-cell origin may be impossible. To get additional diagnostically helpful criteria, texture feature analysis on routinely obtained FNAB's of the salivary gland was applied. In the data set 36/36 cases of low grade B-NHL confirmed by histology and 10/13 histologically confirmed cases of MESA could be classified correctly by means of an image processing system. The chromatin structure of each nucleus was classified by texture features (n = 6), which were determined according to the method of Harms et al. For statistical analysis of the cell types a classification tree based on the commercial program CART was applied. The data set of 49 cases was proved by the crossvalidation test 10 fold. The calculated diagnosis for each case suggests that this method may be helpful in the cytologically doubtful cases.

Loss of growth arrest DNA damage genes expression in oral melanomas

29 oral melanomas were stained immunohistochemically for the GADD34, GADD45 and GADD153. GADD34 was found in 5/29 melanomas and its expression did not exceed 21%, averaging 4.1% of melanoma cells. GADD45 was observed in 8/29 oral melanomas and cell positivity averaged 2.8%. GADD153 was found in 2/29 melanomas and the percentage of positive cells ranged between 0 and 31%, averaging 1.2%. Not one significant correlation between GADD genes in oral melanomas was found. Loss of GADD gene expression and lack of correlation between them show advanced disturbances in their cooperation, leading to a high genetic instability of oral melanoma cells.

Relevance of ploidy related parameters for prognosis in malignant fibrous histiocytomas

Ploidy associated parameters were determined in 161 malignant fibrous histiocytomas (MFH) by DNA image cytometry. The rate of euploid cases in MFH with histopathological grade I was 42%, grade II 16% and grade III 6%. Univariate analyses showed that cases with a low percentage of diploid cells (< 40%) and cases with high rates of aneuploid cells between 4c and 8c (> 9%), octaploid cells (> 0%) and 16-ploid cells (> 0%), high 2.5c (> 60%) and 5c (> 16%) exceeding rates and cases with high DNA indices of the first (> 1.08) and the second (> 3.78) peak had significantly reduced survival rates. Multivariate analyses with Cox regression demonstrated that in addition to grade, only the percentage of aneuploid cells between 4c and 8c, the 5c exceeding rate and the DNA index of the first peak had independent prognostic impact. It was concluded that besides ploidy status and grading, ploidy associated parameters are suited for prediction of survival in MFH.

Comparison of the DNA content in the different steps of cutaneous carcinoma progression

The main aim of this study was to check the application of ploidy related parameters for differential diagnosis between solar keratosis, Bowen's disease and squamous cell carcinoma of the skin. 10 specimens of normal epidermis, 68 solar keratoses, 50 cases of Bowen's disease and 10 squamous cell carcinomas (SCC) were stained with Feulgen and their ploidy status was evaluated with a CAS200 image analyzer. Significant and highly significant differences between groups investigated not only for 5c exceeding rate, but also for the ratios of diploid, aneuploid, tetraploid, octaploid and 16-ploid cells are demonstrated. With respect to ploidy associated parameters solar keratosis is closer related to SCC of the skin than Bowen's disease. These findings are in accordance with a higher risk of progression to SCC inspite of a generally lower degree of atypia.

MAGE-1, GAGE-1/-2 gene expression in FNAB of classic variant of papillary thyroid carcinoma and papillary hyperplasia in nodular goiter

Differentiation of the papillary variant of papillary thyroid carcinoma (PTC) from papillary hyperplasia in nodular goiter may be difficult in fine-needle aspiration biopsy (FNAB) by means of morphology alone. To improve cytodiagnostic accuracy the occurrence of MAGE-1, GAGE-1/-2 gene expression was analyzed by means of RT-PCR. The genes investigated are recognized by autologous T lymphocytes and are expressed in carcinomas of various sites e.g. lung, ovary, colon but not in non-neoplastic tissue except testis. Routinely obtained smears with cytologic diagnosis of PTC confirmed by histology (n=20) and diagnosis of nodular goiter (n=10) were investigated. The MAGE-1, GAGE-1/-2 PCR products were found in 6/20 of the carcinomas but in none of the benign lesions. To identify PCR products automatic gene-sequencing in all positive cases was performed. The data indicate that MAGE-1, GAGE-1/-2 gene expression may give additional information to delineate PTC from papillary hyperplasia in FNAB.

Image cytophotometric DNA analysis of cystadenolymphomas

Warthin's tumour of the parotid gland is generally a benign lesion, consisting of an epithelial and a lymphoid component with unclear histogenetic relationship, 17 cases of Warthin's tumour were investigated for ploidy related parameters by the image analysis system CAS200. All cases investigated were euploid. A diploid DNA pattern (Auer type I) was detected in 7/17 (41%) cases both in the epithelial and lymphoid component of the same tumour. In addition to a diploid cell fraction a tetraploid cell component was found in 7/17 (41%) cases, coincidentally, in the epithelial and lymphoid component (Auer type II). Euploidy in all investigated cases is in agreement with the generally benign nature of Warthin's tumours. The similarity of the DNA pattern (Auer type) in the genetically unrelated epithelial and lymphoid components in most cases (84%) is suggested to be related to a similar functional state of these two components and is discussed in relation to the histogenesis of cystadenolymphomas.

Bcl2 and Bax expression in naevi and melanomas and their relation to ploidy status and proliferation

Twenty-five naevi, 53 primary melanomas, 36 melanoma metastases were stained immunohistochemically for the presence of Bcl2, Bax and Ki-67 antigen in order to define the relation between apoptosis regulators and proliferative activity. Additionally, ploidy status and S-phase were measured. Bax demonstrated a tendency to increase and Bcl2 was decreasing along with melanoma progression. In the group of euploid cases Bcl2 showed a strong significant correlation with Bax expression (p = 0.0001) and both Bcl2 and Bax correlated with Ki-67 expression and S-phase. In the group of aneuploid cases only the correlation Bcl2-Ki-67 was preserved. Others did not reach the level of statistical significance.

Loss of DNA-mismatch repair gene expression in oral melanomas

The defect of DNA mismatch repair is postulated to be responsible for malignant transformation in many types of tumours. The main aim of this study was to evaluate the expression of DNA mismatch repair proteins in 29 cases of oral melanomas and to relate this to the ploidy status of the lesions. MLH1 expression was found in 4/29, MSH2 in 6/29, PMS2 in 2/29 and PMS1 in 0/29 cases investigated. The range of positively stained cells did not exceed 50% with MSH2, and PMS2, or 5% with MLH1. Loss of the DNA mismatch repair gene expression correlated with high aneuploidy ratio, observed in totally negative cases.

Relation between two independent DNA-repair pathways in different groups of naevi

The relation between 2 DNA-repair systems was investigated in 3 groups of naevi (naevus cell naevi, dysplastic naevi, fibromatous naevi) using the correlation coefficient according to Spearman. In the group of naevus cell naevi, only 1 significant correlation between MSH2 and GADD34 expression was found. In the group of dysplastic naevi, 9 significant and highly significant correlations between GADD genes and mismatch repair genes were found. In the group of fibromatous naevi, MLH1 correlated significantly with GADD45 and highly significant with GADD34 expression. Different correlations in naevi groups investigated show the different functional connections between the genes of DNA repair.

Growth arrest DNA damage gene expression in naevi

Thirty-one naevus cell naevi, 30 dysplastic naevi and 12 fibromatous naevi were stained for the presence of p53 and Growth Arrest DNA Damage genes. All naevus cell naevi and fibromatous naevi were highly positive for GADD genes and negative for p53. Dysplastic naevi had significantly lower GADD34 and GADD153 expression as well as higher p53 expression in relation to the other naevi groups. The absence or decrease of GADD genes expression in naevus may indicate a potential malignant transformation.

Expression of DNA mismatch repair genes in naevi

The significant difference of DNA mismatch repair genes expression between naevi and melanomas was demonstrated by our research group in the previous study. The main aim of this study was to compare the expression of MLH1, MSH2, PMS1 and PMS2 in 31 naevus cell naevi, 12 fibromatous naevi and 30 dysplastic naevi. The expression of DNA mismatch repair proteins was found in all naevi investigated. However, the expression (percentage of positively stained cells) was significantly higher in naevus cell naevi than in dysplastic and fibromatous ones.

Prognostic relevance of histologic grading, the cell cycle-associated antigen Ki-S1 and cell cycle regulators in malignant fibrous histiocytomas: a multivariate analysis

The main aim of this study was to compare the prognostic impact of different histologic grading systems, the expression of the cell cycle-associated antigen DNA-topoisomerase-II-alpha (Ki-S1) and the expression of cell cycle regulators in malignant fibrous histiocytomas (MFH) using multivariate analyses. Paraffin-embedded tissue of 161 cases of MFH were studied immunohistochemically for the expression of the proliferation marker Ki-S1, cell cycle regulators (p53, MDM2, waf-1, pRb, p16) and the oncoprotein EGFR. The percentage of immunolabelled tumor cells (index) was assessed. The histologic grade was determined by the two-level grading systems of Costa, Tsujimoto and Pezzi, by the three-level grading systems of Coindre and Van Unnik and by the grading system presented here. Univariate analyses using the LOG rank test showed that all of the applied grading systems produce highly significant differences in survival between the grades of malignancy. Multivariate analyses with COX regression demonstrated that only the grading system presented here, based on the parameters necroses, mitoses and cellularity, had independent prognostic relevance. Moreover, the inclusion of the proposed grading system, the Ki-S1-index and a prognostic index primarily based on the expression of cell cycle regulators into the COX regression was suited for predicting survival in MFH. The grading system presented shows considerable advantages over the grading systems compared in this study for use in the routine pathology of MFH. The prognostic power of the proposed grading system can be enhanced by the combined study of cell cycle regulators and Ki-S1.

How can one explain aneuploidy status in fibromatous and lipomatous naevus cell naevus?

34 lightly fibromatous, 23 heavily fibromatous, 5 lipomatous and 10 naevus cell naevi were stained with Feulgen kit in order to evaluate their ploidy status with CAS 200 image analyzer. 26/34 lightly fibromatous, 18/23 heavily fibromatous, and 5/5 lipomatous naevi were either suspicious for aneuploidy (Auer III) or clearly aneuploid (Auer IV). In contrast all 10/10 naevus cell naevi were euploid. Proliferation (S-phase) was not increased in naevi fibromatously and lipomatously changed. The mechanisms leading to aneuploidy are discussed.

Borderline tumors of the ovary: a clinico-pathologic and immunohistochemical study of 54 cases

OBJECTIVE

To study EGF-R, HER-2/neu (p185), p53, Mib-1 (Ki-67), Bax, Bcl-2, ras expression and ploidy in borderline tumors of the ovary by assessing their frequency, and relationship to histologic type, tumor recurrence and survival.

METHODS

Fifty-four patients with borderline tumors were followed 3-140 months (median: 38 months). Paraffin-embedded sections were stained using monoclonal antibodies against EGF-R, HER-2/neu (p185), p53, Mib-1 (Ki-67), Bax, Bcl-2, and ras. The immunohistochemical findings were correlated to histologic subtype, tumor recurrence, and survival.

RESULTS

Positivity for EGF-R was found in 24% (13/54), in 22% (12/54) p185 was positive, 9% (5/54) of tumors were p53-positive, Mib-1 (Ki-67)-positivity was demonstrable in 46% (25/54). Expression of Bax, Bcl-2, and ras was found in 37% (20/54), 28% (15/54) and in 7% (4/54) of the cases, respectively.

CONCLUSION

The data demonstrate expression of EGF-R, p185/HER-2/neu, p53, Mib-1 (Ki-67), Bax, Bcl-2, and ras in a subgroup of patients with ovarian borderline tumors. Further studies to evaluate their prognostic value are warranted.

Lymph node micrometastases in early gastric carcinoma alone inadequately reflect the new model of metastatic development

Forty early gastric carcinomas were studied retrospectively for the presence of micrometastases in the regional lymph nodes by cytokeratin 18 immunostaining. Tumor typing, grading and staging were reestimated and ploidy of the tumors was assessed with the CAS 200. Micrometastases were found only in 3 cases, while macrometastases were present in 6 cases (micrometastases were present in 3 of those 6 patients). Micrometastases had no effect on patients' survival. It has been concluded that in early gastric carcinoma micrometastases do not influence typing, grading, staging of the tumor and have no prognostic significance. It has also been concluded that it takes more than the diagnosis of micrometastasis alone to estimate its real prognostic significance, especially in view of the new by emerging concept of cancer metastatic development.

The role of nm23 in melanoma progression and its prognostic significance

The nm23 monoclonal antibody directed to specific antigen was applied for investigation of 29 benign naevi, 59 melanomas of different Clark level and locations, 4 lymph node and 28 organ metastases, using quantitative immunohistochemistry. The reduced expression of nm23 protein was associated with the tumor progression. A statistically significant difference (p = 0.0014) was found in nm23 protein expression between naevi and malignant melanomas. Additionally, a reduced protein level in metastases was found. A strong correlation was found between nm23 expression and survival of patients as well as the presence of metastasis (p = 0.0003).

Comparison of the DNA content in recurrent and nonrecurrent basaliomas of the face

The ploidy status of 5 recurrent and 7 nonrecurrent basaliomas was investigated using a CAS 200 image analyser. All recurrent basaliomas were aneuploid in contrast to nonrecurrent ones representing the euploid status. The percentage of cells in S phase in recurrent basaliomas was twice as high as in nonrecurrent ones. The authors conclude that aneuploidy in primary tumour can be a warning signal for recurrences and these patients should undergo special control.

Expression of growth arrest and DNA damage genes and DNA mismatch repair genes in snake melanomas

Snake melanomas are rare tumours and their pathogenesis is still unclear. In this study the expression of DNA mismatch repair genes and Growth Arrest DNA Damage Genes was investigated. The expression only of 3 of them GADD34, MLH1 and MSH2 was found. The role of these genes in animal tumorigenesis is discussed.

The value of PCR technique in fine needle aspiration biopsy of salivary gland for diagnosis of low-grade B-cell lymphoma

In fine needle aspiration biopsy (FNAB) of salivary gland delineation of low-grade B-cell lymphoma from benign lymphoid lesions of myoepithelial sialadenitis (MESA) may be very difficult by means of cytomorphological criteria alone. To improve cytodiagnosis PCR technique was applied on routinely stained smears to determine clonal status by amplifying the third complementarity-determining region (CDR3) of the hypervariable domain of the immunoglobulin heavy chain. Twelve cases diagnosed cytologically as suspicious of low-grade B-NHL with following histology of B-NHL (n = 5) or MESA (n = 7) were analyzed. The CDR3-IgH PCR produced distinct bands in 10/12 cases. The PCR products were analyzed with Genescan software on the DNA sequencer, which demonstrated monoclonal bands in all NHLs and in one case of MESA. The results indicate that PCR technique may be helpful in improving cytodiagnostic accuracy for recognition of low-grade B-NHL of salivary gland.

Comparison of ploidy status of melanoma metastases in different locations

The main aim of this study was to evaluate the DNA content and ploidy status of 29 melanoma metastases in lymph nodes, as well as 10 liver, 12 brain, 13 lung and 2 gastrointestinal metastases. All cases investigated were either suspicious to be aneuploid or clearly aneuploid. This study demonstrates differences of ploidy related parameters between melanoma metastases of different locations. The 5c exceeding rate values were the lowest in lymph node metastases and the highest in melanoma cells in the brain (p<0.05). The rate of cells in S-phase ranged between 12% in gastrointestinal metastases and 23% in liver metastases. The melanoma cells, which formed liver metastases had smaller area, lower mass and bigger shape factors in comparison with melanoma cells in lymph nodes.

Comparison of the DNA content in low and high grade non-Hodgkin lymphomas

In the fine needle aspiration biopsy (FNAB) of lymph nodes, the deliniation of low grade non-Hodgkin lymphoma (NHL) from high grade NHL by means of morphology may be difficult. To gain additional diagnostically helpful criteria, cytophotometric analysis of the DNA content was applied. 117 specimens of NHL were examined, including 51 cases of low grade NHL (14 centroblastic-centrocytic, 9 centrocytic, 14 lymphoplasmocytoid immnocytomas and 14 chronic Iymphocytic leukemias) and 66 cases of high grade NHL (15 centroblastic, 18 immunoblastic, 7 Burkitt and 26 lymphoblastic). The smears were stained with Feulgen and were evaluated by image analysis (CAS 200, Becton- Dickinson). The 5 c exceeding rate differed significantly (p = 0.0081) between low- and hig-grade NHL. In the group of low grade NHL, clearly aneuploid cases were not found (Auer type I 32%, type II 62%, type III 6% of cases). The high grade NHL's showed histograms Auer type II (10% of cases), type III (62% of cases) as well as clearly aneuploid type IV (28% of cases). In summary, image cytophotometry can be used along side morphology to differentiate between low and high grade lymphomas in morphologically difficult cases.

Comparative cytophotometric analysis of reactive lymphoid hyperplasia and low malignant non-Hodgkin lymphoma

In fine needle aspiration biopsy (FNAB) of lymph nodes, differential diagnosis between reactive lymphoid hyperplasia (RLH) and low grade non-Hodgkin lymphoma (NHL) may be sometimes difficult. Cytophotometric analysis of DNA content using image analysis has found practical application in the determination of malignancy in different tumours. In this study, image cytometry was applied to compare the ploidy status of the above mentioned lesions to obtain diagnostically helpful information. Thirty smears of histologically proven low grade NHL (10 follicular lymphomas of centroblastic-centrocytic type, 10 lympho-plasmocytoid immunocytomas, 10 chronic lymphocytic leukemias) and 15 smears of RLH were stained with Feulgen and examined by image analysis (CAS 200, Becton Dickinson). The 5c exceeding rate was determined according to the Boecking's definition of aneuploidy. Concerning the histogram types the Auer classification was used. The aneuploidy was found in 4/10 follicular lymphomas and 4/10 lymphoplasmocytoid immunocytomas. All chronic lymphocytic leukemias were diploid. In none RLH a 5c exceeding rate was found. The results verify the value of image cytophotometry as a helpful method in some diagnostically difficult cases.

Grading system for breast cancer

As recurrence rates in breast cancer depend significantly on degree of malignancy (6-9) and mitotic rates as part of the grading system are difficult to assess in exact manner, we widened the grading system by evaluation of the proliferative compartment to get more information about proliferation activity as an important factor for tumor-progression (15, 16). This additional analysis can be used as a control factor for the correctness of the evaluation of mitotic activity. We practice this procedure at present as a "working formulation". New antibodies are in preparation which allow to exclude the highly variable G1-Phase. Further precision and control of degree of malignancy can be achieved by photometric analysis of S-Phase, 5c exceeding rate and state of ploidy according to Auer scheme.

Analysis of the DNA content in Bowen's disease

The aim of this study was to evaluate the DNA content in Bowen's disease in comparison to healthy epidermis applying image cytophotometry. The material investigated was derived from 50 patients with Bowen's disease and 10 patients with healthy skin. For comparison of both groups the Kruskal-Wallis test was applied. Slides were stained with Feulgen and were evaluated with CAS-200 image analyzer. Only 7/50 morbus Bowen cases represented euploid histogram. The others 43/50 were either conspicious to be aneuploid (29/50) or clearly aneuploid (14/50). In contrast, all normal epidermis (10/10) were clearly euploid. Morbus Bowen cases demonstrated significantly higher 5c exceeding rate (p=0.0012) and significantly more cells in the S-phase (p=0.017). High aneuploidy rate and increased proliferative activity in morbus Bowen cases support the classification of these lesion as carcinoma in situ.

Immunohistochemical and photometric analysis of snake-melanomas

Snake melanomas are very rare tumours in the class of Reptilia. This study demonstrates the ploidy status and S100 and HMB45 expression in snake melanomas in connection to their morphology and clinical history.

Differential expression of growth arrest, DNA damage genes and tumour suppressor gene p53 in naevi and malignant melanomas

Twenty nine benign naevi and 59 melanomas of different Clark level and locations were stained immunohistochemically for the presence of p53 and 3 members of Growth Arrest. DNA Damage inducible family: GADD 34, GADD 45 and GADD 153. All naevi were p53 negative and highly GADD positive. Differences in the expression of all 3 GADD proteins between naevi and melanomas were highly significant (p = 0.0001). The expression of p53 increased and the expression of GADD proteins decreased with the Clark level of melanoma thickness. The survival time of patients correlated negatively with p53 positivity and positively with GADD 45 and 153 expression. Prognostic significance for GADD 34 was not found. Our conclusion is that GADD proteins play an important role in the malignant transformation of naevus to melanoma and GADD 45 and GADD 153 proteins can influence patient survival.

Prognostic value of contrast-enhanced MR mammography in patients with breast cancer

The objective of this study was to evaluate the prognostic value of contrast-enhanced MR mammography in patients with breast cancer. A total of 190 patients with breast cancer (37 noninvasive carcinomas, 153 invasive carcinomas) underwent dynamic contrast-enhanced MR mammography preoperatively. Using 1.5-T unit, T1-weighted sequences (2D FLASH) were obtained repeatedly one time before and five times after IV administration of 0.1 mmol gadopentetate-dimeglumine per kilogram body weight. The findings on MR imaging were correlated with histopathologically defined prognostic factors (histological type, tumor size, tumor grading, metastasis in lymph nodes). In addition, immunohistochemically defined prognostic factors (c-erbB-1, c-erbB-2, p53, Ki-67) were correlated with the signal increase on MR mammogram in 40 patients. There was no significant correlation between the findings on MR mammography and the histopathological type of carcinoma, the grading, and the lymphonodular status. Noninvasive carcinomas showed a higher rate of moderate (38 %) or low (27 %) enhancement on MR imaging than invasive carcinomas (6 and 3 %). The results on MR mammography and the results of immunohistochemical stainings did not correlate significantly. Noninvasive carcinomas showed significantly lower enhancement than invasive carcinomas. However, the signal behavior of contrast-enhanced MR mammography is not related to established histopathological prognostic parameters as subtyping, grading, nodal status, and the expression of certain oncogenes/tumor suppressor genes.

Expression rate of vinculin isoforms in human aortocoronary saphenous vein grafts

Aortocoronary bypass conduits derived from saphenous veins usually develop diffuse intimal thickening, one of the major causes of haemodynamically relevant graft stenosis. To elucidate the role of smooth muscle cell proliferation in late graft failure, specimens from highly stenotic or occluded vein grafts implanted into the arterial circulation for more than 5 years were tested for their expression rate of meta-vinculin. Since the cytoskeletal protein meta-vinculin is present exclusively in contractile smooth muscle cells, the determination of the relative amounts of meta-vinculin (150 kDa) and its low-molecular weight isoform vinculin (130 kDa) allows characterization of the phenotypic status of smooth muscle cells. Using immunoblotting techniques, the quantitative relation of meta-vinculin in tissue samples obtained from autoptic vein grafts (n=10) was measured and compared with those of native saphenous veins (n=6). In vein grafts, the fractional meta-vinculin content of the total vinculin immunoreactivity ranged from 32%-46% (mean 39.6%), whereas the range was 39%-53% (mean 46.7%) in native veins. By applying Student's t-test, a statistical significance was not demonstrated suggesting that the majority of smooth muscle cells in intimal thickenings consisted of a contractile phenotype. Immunohistochemically, the vinculin immunoreactivity in the intimal layer of vein grafts was reduced as compared to native saphenous veins. The distribution of vinculin in grafted veins closely resembled that in arteriosclerotic coronary arteries with intimal thickening. Hence, our biochemical data demonstrate parallels between the pathogenesis of late vein graft stenosis and degenerative arteriosclerotic lesions.

Mib-1 evaluated proliferative activity in ovarian cancer with respect to prognostic significance

In the present study, tumor tissue of 251 patients with ovarian cancer was immunohistochemically analysed for proliferative activity using the monoclonal antibody mib-1 and the analyse system CAS 200. The rate of the growth fraction varied from 0% to 71% mib-1 positive tumor cells with a median of 17%. There was a strongly significant association between proliferative activity and the degree of histological differentiation (p = 0.0005), whereas there was no significant correlation with tumor stage and histological subtypes. Using the median as the cut-off point, patients with higher proliferating tumors (> or = 17%) had a statistically significant worse prognosis (p = 0.0431). Especially in the group of patients with grade 1 and grade 2 tumors, measurement of the proliferative activity is of help for prediction of the postoperative survival time of patients (p = 0.0336), suggesting that measurement of the growth fraction estimated by mib-1 reflects more closely the degree of tumor differentiation. However, multivariate analyses cannot confirm these results.